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Treponin test tells the tale

Advances in medical science change the way that we are affected by certain illnesses and the way we diagnose them. These advances in turn affect critical-illness cover. One example is the growing use of troponin tests to help diagnose heart attacks and other illnesses of the heart.

The current heart attack definition used in critical-illness policies makes no mention of these latest diagnostic tests, which can leave a question mark over whether or not a heart attack claim is valid.

This is why the ABI has issued a consultation paper recommending a change to the current heart attack definition to bring it into line with current medical science.

We need to understand how troponin tests are used, the effect that they are increasingly having on critical-illness policies and why the current heart attack definition needs to change. To do this, we first need to know what a troponin test actually is.

When someone has a heart attack, biochemical markers called troponins are released into the bloodstream. The test measures the presence of troponins in a blood sample. After a heart attack, the level follows a pattern of a rise and fall which can be tracked by taking successive blood samples over a period of time.

When someone is brought into Accident & Emergency with a suspected heart attack, hospitals are increasingly starting to use troponin tests to tell whether or not the person has had a heart attack.

The test is quick and cheap and can help doctors decide what treatment the patient requires and whether the patient needs to stay in hospital or is safe to be sent home.

However, troponin can be released into the bloodstream for reasons other than a heart attack. If the troponin release is caused by heart surgery, this may be self-evident. However, because troponin can be released for a number of reasons, doctors will often need to do further tests to understand the patient&#39s condition and assess what treatment the patient needs. If the patient has had a heart attack, this would normally show up on an ECG or an ultrasound or nuc-lear (thallium) heart scan.

The ABI critical illness working party is proposing a new definition that would include evidence of a rise in troponins as one of the three factors that constitute a heart attack. Insurance companies would pay out on claims for troponin where this is supported by other evidence of a heart attack in the form of typical chest pain and either a positive ECG or a heart scan.

We believe that this is in line with the recent advances in medical science and the tests that doctors are increasingly using to diagnose a heart attack. Of course, there will be many cases where evidence of raised troponins is not available.

There could be a number of reasons why a troponin test is not done. It may be because the patient does not get to hospital until later on. Another reason may be because the hospital does not use troponin tests – not all do. However, a claim can still be paid based on the traditional evidence, as with the current definition.

Whenever the industry considers changing a critical-illness definition, a key consideration is how the change will affect premiums.

Clearly, it is in everyone&#39s interest to ensure that critical-illness cover remains affordable and premium increases are avoided wherever possible. On this occasion, we do not believe there will be any significant impact on prem-iums for two main reasons.

First, there is an increasing gap between the evid-ence that hospitals will have available to support a heart attack claim and the evid-ence asked for in the current definition.

The heart attack definition proposed by the ABI critical-illness working party aims to close this gap and, by accepting a wider range of evidence, potentially offers slightly wider cover than a strict interpretation of the current definition.

However, when insurers get a claim for a heart attack that falls into the current gap, they will need to interpret the evidence in a reasonable way. If we compare the proposed wording with a reasonable interpretation of the current definition, the cover is comparable.

Second, the overall incidence of heart disease in the UK is falling as we become a healthier nation. While actuaries make an allowance for this in setting premium rates, it provides a more favourable environment for introducing the new definition.

The ABI is looking for comments on the proposed definition (see box) by the end of January 2002. After the consultation process, if a change of definition is accepted, ABI plans to publish the final version of the new definition together with an implementation deadline. The plan is for this to be in May as part of the review of the Statement of best practice for critical-illness cover.

The new definition would have to be used on all new policies taken out after the implementation deadline. After the final definition is published, insurers would be free to adopt the new definition ahead of the deadline if they wish and may also choose to apply the new definition to existing policyholders. These would be decisions for individual insurers.

All responses should be sent via email to nick.kirwan@virgin.net

Heart attack:

The death of a portion of heart muscle, due to inadequate blood supply, that has resulted in each of the following:

typical chest pain; and ·

new electrocardiographic changes or relevant findings on a heart scan; and

the characteristic rise of cardiac enzymes or troponins. The evidence must be consistent with acute myocardial infarction.

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